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  #1  
Old 02-18-2012
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Arrow NBME 2 Block 3 Discussion

QUESTION 3:

If you're wondering why the answer is Genetic Heterogeneity. There are 3 types of Heterogeneity. This one is phenotypic heterogeneity.

Allelic Heterogeneity: Different mutations in the same locus causing similar phenotypes. Example, Duchenne/Becker

Locus Heterogenity: Mutations in different loci with the same disease phenotype. Example, Albinism,OGI.

Phenotypic heterogeneity: mutations of same gene causing different phenotypes.


QUESTION 10:

I think the answer is either D or E. Cortisone shot is not the right answer for this as she says her hands are weak, says nothing about pain or discomfort.

I would think the answer is E as that is a solution for her current problem, which is she needs to take a bath.

Discuss..........


QUESTION 19

Looks like vascular dementia to me. That lesion looks like necrotic, hemorragic areas. Also looks liquefactive which happens with vascular problems.

Discuss...........


QUESTION 43:

Eukaryotic proteins that exist as a nonmembrane-associated, glycosylated, disulfide-linked dimer in the mature form are generally found in which of the following?

A) Cytoplasm
B) extracellular space
C) mitochondrial matrix
D) nuclear matrix
E) nuclear pore

I have no idea what the answer is. If you could please give an explanation with this.


QUESTION 44:

I pick F.

Standard deviation stays same whether you increase or decrease sample size, which means that the width of the 95% confidence interval stays same.

As you decrease sample size the standard error will increase. One really good way to decrease standard error in any study is to increase the sample size.
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  #2  
Old 02-18-2012
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Yes question 3 is Li Fraumeni syndrome......nice explanation

Q10

Yes i marked E,option D wouldnt address her acute problem so E seems more correct.I think key is wrong here...

Q19

I think 83 years of age with progressive dementia directs towards Alzheimers Disease.most probably slide denotes Amyloid deposition in the brain.
Vascular dementia wont be progressive i guess......

Q 43

I too got it wrong. What i think they are asking is after the protein modification (which they mention as glycosylation......) what is the ultimate destination of these protein.So after modification proteins are ultimately secreted extracellularly so ECF is the answer. Not sure but......

Q 44

SE = SD/n
so as the sample size decreases SE increases.


Now Range of CI = Mean + SE so since SE is increased So range will increase too.E is correct.




Can you please help with these Question
Q 14
Lysyl oxidase requires Cu as a Cofactor so why not a defect in Ceruloplasmin.

Q 46

In my first aid i have written the primary cell mediating Contact dermatitis is CD8 cells.Must have been
mentioned in either Kaplan Q bank or UW . Can you throw light on it.....

Thanks
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Quote:
Originally Posted by jinni View Post
Can you please help with these Question
Q 14
Lysyl oxidase requires Cu as a Cofactor so why not a defect in Ceruloplasmin.
Ceruloplasmin is just the carrier protein for Cu. Even if there is a defect there will not be a deficiency of Cu, rather the free level will be increased. Still plenty of Cu for Lysyl Oxidase.


Quote:
Originally Posted by jinni View Post
Q 46

In my first aid i have written the primary cell mediating Contact dermatitis is CD8 cells.Must have been
mentioned in either Kaplan Q bank or UW . Can you throw light on it.....
Maybe you are confusing transplant rejection with type 4 hypersensitivity??

In delayed type 4 hypersensitivity it is the CD4 T cell which is responsible, specifically TH1 cells. They release cytokines leading to macrophage activation.
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Quote:
Originally Posted by haga View Post
Ceruloplasmin is just the carrier protein for Cu. Even if there is a defect there will not be a deficiency of Cu, rather the free level will be increased. Still plenty of Cu for Lysyl Oxidase.



Maybe you are confusing transplant rejection with type 4 hypersensitivity??

In delayed type 4 hypersensitivity it is the CD4 T cell which is responsible, specifically TH1 cells. They release cytokines leading to macrophage activation.
Q14

Got it.


Q 46

For what i am mentioning Pls see Qid 1133 in UW
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Quote:
Originally Posted by jinni View Post
Q 46

For what i am mentioning Pls see Qid 1133 in UW
Don't have UW. But I distinctly remember when I did Kaplan QBank and also from Goljan that this is the exact mechanism.

Maybe you can type out the question and answer.
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Old 02-18-2012
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Qs 10 .. yes E appears correct but dont know if need to offer a treatment option to her if she wants to take a emergency shot like A ....... becoz even C might appear correct then as we need to show empathy to our patients ....... D is definitely not correct as shes in pain its annoying to ask her join a support group now .......

so i dont know which one would fit .....

Qs 19 is Alzheimers Disease ....slow progressive , no h/o of HT or earlier defect due to it so its not Vascular ......

Qs 43 i think is talking about collagen , mature part found extracellularly ...

Qs 44 E ...... as jinni explained .......

Qs 46 ...... contact dermatitis am confused should be C as even i have written CD8 from UW type 4 but becoz macrophage engulf it present it to cd4 lyphoctyes which releases cytokines ......E can also be a ans

i ususally thought they ask this for CD8 but cd 8 alone doesnot cause type 4 so it def needs these components so as the Qs says most likely it could be E ........

Hey please could you explain 1 , 4 , 15 ......

thanks........
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Question 1:

Bit of a trick question, Normally we assess memory and I immediately thought of 4 words after 5 minutes but then when you read the question it says test CONCENTRATION.

Only C and E would test that, and between those 2 C is the far better answer. Very quick test to determine whether the pt. can concentrate on the task at hand.


Question 4:

Eythropoietin will cause increased Red cell mass. An increase in RBCs will further cause an increase in Plasma Volume. Since it will have a hemodynamic effect the only answer choice that fits this will be hypertension.


Question 15:

This is a typical explanation or ARDS. Read from FA.

Diffuse alveolar damage (ALVEOLITIS), increased capillary permeability (INTERSTITIAL EDEMA), initial damage due to neutrophils (INFLAMMATARY CELL ACCUMULATION), repair by type 2 pneumocytes (HYPERTROPHY & HYPERPLASIA to start repair).

ARDS is the early and central event and the eventual late finding is PULMONARY FIBROSIS which is the eventual sequela of ARDS.
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  #8  
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Qs 4 i thought increase rbcs increase Hb production , inc consumption of B6 and neuropathy ..........
but your right its Ht ...........

thanks .......
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does anyone has NBME 2 offlines ???
is it high yield???
please send it to me if any one has it offline
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For Q 4 see this link

http://www.macmillan.org.uk/Cancerinformation/Cancertreatment/Treatmenttypes/Supportivetherapies/Erythropoietin.aspx#DynamicJumpMenuManager_6_Ancho r_8

For Q 46 UW explanation has lead to the dilemma.I am going to post it as a seperate thread on the forum.....lets see what other have to say.

I think this ends Block 3.
Thanks
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Default NBME 12 block 3 Q10

Patient with rheumatoid arthritis...
I would go with a instead of e.... any input?
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